In WV, both the Title V and Medicaid agencies reside in DHHR and are physically located in the same office building.  OMCFH facilitates an annual review and renewal of the required Title V-Medicaid Inter-Agency Agreements (IAA). Medicaid has designated a formal point of contact for the Office to assure coordination and continuity of operations.  This point of contact reaches out to the office via routine walk-throughs and check-ins assuring that they are informed of OMCFH issues and concerns.  When ideas or issues are identified, they then facilitate follow-up with appropriate Medicaid staff in a timely manner. 

This partnership extends to significant financial support of many OMCFH operations.  Medicaid is a funder for Children with Special Health Care Needs, Birth to Three, HealthCheck, Right From The Start (the State’s Medicaid Home Visitation Program) and Breast and Cervical Cancer Screening.  This allows the Office to leverage resources, but also assures additional coordination between the two agencies via program specific MOUs.  This establishes a collaborative environment whereby the agencies work together to develop policy for service delivery which extends to other operations like oral health, maternity services, and newborn screening.  On July 1, 2021, Medicaid increased coverage for postpartum care for up to one year.  As a result, Right From the Start also increased home visitation services for up to one year.  In 2020, WV CHIP increased coverage to include pregnant women up to 300% of the FPL.  As a result, OMCFH increased the MCH Maternity Services Program eligibility up to 325% of the FPL based on family size, including the unborn child.  The MCH Maternity Services Program also covers pregnant teens under age 19 with no other insurance and prenatal care, associated/prenatal lab work and OB provider delivery fee for non-US citizens.  WV Medicaid has a special policy provision that may provide delivery and inpatient coverage. 

The Office approaches outreach from a systems perspective.  For example, the Social Security Administration routinely provides a list of children who have applied for social security.  In turn, the Office reaches out with enrollment packages for Children with Special Health Care Needs services.  The Office also works with the Health Statistics Center to use birth certificate information to complete a monthly mailing to new parents with targeted outreach information.  HeathCheck staff routinely contact families enrolled in fee-for-service Medicaid to facilitate the administrative components of Early and Periodic Screening, Diagnosis and Treatment (EPSDT), including scheduling of well-child exams. Likewise, nine community based HealthCheck Regional Program Specialists serve to equip West Virginia's Medicaid providers with the necessary tools and knowledge to carry out EPSDT services consistent with the standard for pediatric preventive health care, i.e. Bright Futures, as well as provide ongoing technical assistance to enable EPSDT. In addition to these activities, staff often attend community baby showers, health fairs and other events to share information about the services provided by OMCFH and Medicaid.

Like many states, WV has commissioned managed care organizations (MCOs) to provide health services to its Medicaid members. The Bureau for Medical Services (BMS), Center for Managed Care, initiated a risk-based managed care program called Mountain Health Trust (MHT) in September 1996.  Mountain Health Trust includes Medicaid and CHIP and provides managed care services to approximately 87% of the state’s Medicaid and CHIP membership. Populations covered under managed care include most adults and children, pregnant women, and members receiving Supplemental Security Income (SSI). The Bureau contracts with three Managed Care Organizations (MCOs) for the provision of Medicaid medically necessary services. Services carved out of managed care include point of sale pharmacy, long-term care, home and community-based waivers and non-emergency medical transportation services. On January 1, 2021 West Virginia Children's Health Insurance Program (WVCHIP) members were included in the MHT program. 

Through the Pediatric Medical Advisory Board and HealthCheck Program, the Office has always set standards for the State’s EPSDT Program, this role has remained and, in some areas, expanded with the State’s utilization of MCOs. In 2020, children and youth in the foster care system and individuals receiving adoption assistance transitioned from a fee for service environment to Medicaid managed care. Aetna Better Health of West Virginia received the contract for this specialized managed care program.  The Title V Director was involved in every aspect of this transition.  Likewise, the Title V CSHCN Director and CSHCN Nursing Director continue to work with Aetna Better Health of West Virginia on a weekly basis to facilitate successful implementation of an electronic health record (EHR) system to include, at a minimum, the child/youth’s chronic health problems, allergies, medications, psychosocial and family histories, trauma history, developmental and immunization information, and shared plan of care that simplifies implementation of key functions of the medical home, including but not limited to, comprehensive care coordination, communication, and patient- and family-centered care. WV’s strong Title V-Medicaid partnership continues to bring about reduced fragmentation and to deliver needed support and services for this population in the most integrated, appropriate, and cost-effective way possible.

House Bill 2266, passed by the WV Legislature on April 10, 2021, amended and reenacted §9-5-12 of the Code of West Virginia to extend Medicaid coverage to pregnant women and their newborn infants up to 185% of the federal poverty level and to provide coverage up to 1 year postpartum, effective July 1, 2021.  Said postpartum care may include the provision of care coordination services (targeted case management from Medicaid’s perspective) and health education to Medicaid eligible pregnant women via the Right from the Start Program administered by West Virginia’s Title V agency.